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Risk Factors for Targeted Fungal and Mycobacterial Infections in Patients Taking Tumor Necrosis Factor Inhibitors

Elizabeth Salt1, Amanda T Wiggins1, Mary Kay Rayens1

  • 1University of Kentucky, Lexington.

Arthritis & Rheumatology (Hoboken, N.J.)
|October 17, 2015
PubMed
Abstract

Insights

Tumor necrosis factor inhibitors (TNFi) rarely lead to fungal or mycobacterial infections. However, patients taking prednisone alongside TNFi were twice as likely to develop these infections, highlighting a key predictor.

Area of Science:

  • Infectious Diseases
  • Rheumatology
  • Pharmacology

Background:

  • Tumor necrosis factor inhibitors (TNFi) are widely used for inflammatory conditions.
  • Fungal and mycobacterial infections are potential opportunistic infections in immunocompromised patients.
  • Predictors for these infections in TNFi users require identification.

Purpose of the Study:

  • To identify predictors of medical care receipt for fungal or mycobacterial infections in patients prescribed TNFi.
  • To investigate the association between prednisone use and the development of these infections.

Main Methods:

  • A case-control study was conducted using US health claims data (2007-2009).
  • Data included 30,772 patients on TNFi, with 158 developing targeted infections.
  • Statistical analyses included descriptive statistics, t-tests, chi-square, Fisher's exact test, and logistic regression.

Main Results:

  • Fungal/mycobacterial infections occurred in 0.51% of TNFi users.
  • Tuberculosis and histoplasmosis were the most common infections.
  • Prednisone use was significantly higher in cases (55%) vs. controls (37%; P < 0.001).
  • Prednisone users were twice as likely to seek care for these infections (OR 2.03; P < 0.001).

Conclusions:

  • Targeted fungal or mycobacterial infections are rare in TNFi users.
  • Concomitant prednisone use is a significant predictor for developing these infections in TNFi patients.

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